Статья
Современные методы ограничения системного воспалительного ответа при коррекции врожденных пороков сердца у детей в условиях искусственного кровообращения
Основные положения. В статье описаны патофизиологические аспекты искусственного кровообращения и механизмы развития системного воспалительного ответа при кардиохирургических операциях у детей. Представлены наиболее актуальные методы борьбы с системным воспалительным ответом, среди которых как способы в составе искусственного кровообращения, так и фармакологические методики.Рост числа детей с врожденными пороками сердца требует разработки более совершенных технологий оперативного лечения. Однако хирургические методы коррекции по-прежнему в большинстве случаев требуют применения искусственного кровообращения. Несмотря на значительный прогресс в совершенствовании техники проведения искусственного кровообращения, остается нерешенным и актуальным вопрос системного воспалительного ответа (СВО), сопровождающего операции такого рода. В обзоре подробно представлены причины и механизмы развития данного осложнения. Охарактеризованы наиболее популярные методы ограничения СВО: стандартная и модифицированная ультрафильтрация, лейкоцитарные фильтры, фармакологическое воздействие (применение системных глюкокортикоидов, апротинина и антиоксидантов). Кроме того, оценена роль кардиоплегии и гипотермии в процессе ограничения системного воспаления. В кардиохирургических центрах по всему миру используют различные технические и фармакологические подходы, опираясь на результаты релевантных исследований, при этом до сих пор не разработаны четкие клинические рекомендации, направленные на снижение СВО во время искусственного кровообращения у детей. Указанное осложнение остается значимой проблемой у детей реанимационного профиля, определяя тяжесть состояния, удлиняя срок госпитализации и уменьшая выживаемость данной категории больных.
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